Objective To understand the epidemic characteristics of different virus types of hand, foot and mouth disease (HFMD) in Zhaotong City, and provide guidance and recommendations for the prevention and control of HFMD, and to analyze seasonal characteristics of different virus types of HFMD in Zhaotong City. Methods The epidemiological characteristics of different virus types of HFMD in Zhaotong City from 2014 to 2017 were analyzed using the concentration and circular distribution methods. Results The main pathogens detected were EV71, Cox A16 and other enteroviruses, which were 216, 182, and 294, respectively, accounting for 57.45%, 73.44%, and 67.11%. M was 0.86, indicating that EV71 had strong seasonality. The Rayleigh test showed statistically significant differences (Z = 99.53, P <0.001). ā = 157 °, the peak day of onset was May 10, similar to untyped (May 16), the peak period was April 21-June 1, and the epidemic period was April 1-June 21. Conclusion According to the incubation period of hand-foot-mouth disease and the period of time during which the vaccine develops protective effects, vaccination of hand-foot-mouth disease vaccine at the peak period has a good guiding significance for the timeliness and pertinence of vaccination.

Objective: To investigate the prevalence of glucose-6-phosphate dehydrogenase (G6PD) gene mutation in newborns of Hainan Province, and to provide reference for prevention and treatment of G6PD deficiency in this region. Methods: Neonatal disease screening filter paper dry blood spots from all midwifery agencies were collected in 18 cities (counties) in Hainan Province from January to June 2016, G6PD activity screening test was conducted at Neonatal Disease Screening Center, Hainan Women and Children's Medical Center, and the enzyme activity was normal when fluorescence value > 1 600, and enzyme deficiency when fluorescence value ≤1 600. Referred to "China's Major Birth Defects and Genetic Diseases Survey and Biological Resources Collection", women newborns (3 371 cases) with fluorescence values ≤2 200 and men newborns (1 620 cases) with fluorescence values ≤1 700 were included in the study. Molecular screening was performed using multicolor melting curve analysis (MMCA), and the distribution and mutation characteristics of G6PD gene mutants were analyzed. Results: Among the 4 991 newborns, 2 111 cases with G6PD gene mutation, and the detection rate was 42.30% (2 111/4 991). A total of 27 G6PD gene mutants were found, including 14 single mutants and 13 composite mutants. The mutation detection rates of c.1376 G>T (21.42%, 1 069/4 991), c.1388 G>A (11.54%, 576/4 991), c.95 A>G (2.40%, 120/4 991) and c.871 G>A (2.24%, 112/4 991) were higher. The mutation detection rate (61.54%, 136/221) of Baisha County (inland area) was the highest, and the mutation detection rate (22.15%, 64/289) of Wenchang City (coastal area) was the lowest. The mutation detection rate (49.88%, 628/1 259) of the Li nationality was the highest. A total of 873 female heterozygotes were detected, including 13 gene mutants, of which 44.67% (390/873) with normal enzyme activity. The c.86 C>T heterozygous mutation was first detected in a sample of Li female with normal enzyme activity. Conclusions Hainan Province is the high incidence area of G6PD gene mutation, the most common mutations are c.1376 G>T, c.1388 G>A, c.95 A>G and c.871 G>A in newborns. Inland area is the high incidence area, and Li nationality is the high incidence population.

Objective To investigate the treatment,outcomes and disease burden of severe hand-foot-and mouth diseases(HFMD),and to evaluate the compliance to the 2011 guideline for treatment in regions with a high in-cidence of HFMD.Methods A collaborative study group was established including Children's Hospital of Fudan Uni-versity,Jiangxi Provincial Children's Hospital,Anhui Provincial Children's Hospital,Linyi People's Hospital and the Second People's Hospital of Fuyang City.Clinical manifestation,treatment,prognosis and other data of severe HFMD pa-tients were prospectively collected by filling out a survey form in real time from April 2014 to October 2016. Results Two hundred and twenty-six severe HFMD cases were collected during the research time,including 114 ca-ses in stage 2,75 cases in stage 3,and 37 cases in stage 4.Two hundred and twenty-one cases(97.8%)were given mannitol,with a mortality of 6.2%;91 cases(40.3%)were given mannitol and glycerol fructose,with a mortality of 3.3%;the combined use of mannitol and glycerol fructose might have a better result than the single use of mannitol. One hundred and ninety-eight cases(87.6%)were given intravenous immunoglobulin(IVIG).One hundred and ninety cases(84.1%)were given antiviral drugs.One hundred and forty-five cases(64.2%)were given hormone therapy,and the use of hormone could reduce temperature,but did not reduce the mortality.One hundred and fifty cases (66.4%)needed vasoactive agent,including milrinone,dobutamine,phentolamine and sodium nitroprusside. The vasoactive agent use in stage 3 and 4 were 88.0%(66/75 cases)and 91.9%(34/37 cases),respectively.Sixty-nine cases(30.5%)received continuous positive airway pressure(CPAP),91 cases(40.3%)with mechanical ventila-tion,peak inspiratory pressure(PIP)≥20 cmH2O(1 cmH2O=0.098 kPa)accounted for 61.6%(53/86 cases),po-sitive end-expiratory pressure(PEEP)≥10 cmH2O accounted for 36.3%(33/91 cases).The mean mechanical ven-tilation time was(125.9 ± 101.8)h.Eleven cases(4.86%)died or died after giving up treatment,in which the mortality in stage 3 was 6.7%(5/75 cases),and the mortality in stage 4 was 16.2%(6/37 cases).The death causes were respiratory failure,pulmonary hemorrhage,and circulatory failure. The average time from onset to death was (5.91 ± 5.26)(1-15)d.Length of stay in hospital was(9.18 ± 5.16)(1-37)d in which length of stay in hospi-tal in stage 3 and 4 were(11.3 ± 6.35)d,(11.4 ± 6.62)d,respectively,which were significantly longer than that in stage 2[(7.50 ± 3.04)d],and the difference was statistically significant(P <0.05). The cost was(19 136 ± 12 556)CNY,of which the cost in stage 3 and 4 was(23 121 ± 13 846)CNY,(29 849 ± 16 015)CNY,respectively, which were significantly higher than that in stage 2[(12 961 ± 4 272)CNY],and the difference was statistically sig-nificant(P<0.05). Multivariate analysis found that respiratory rhythm abnormality,capillary refill time more than 3 seconds were risk factors for the deaths in the severe HFMD.Conclusion The 2011 edition of guidelines for treat-ment of children with severe HFMD was well executed.Hormone,IVIG,antiviral drugs did not significantly reduce the mortality of severe HFMD in children.

Objective To investigate the clinical features of severe hand,foot and mouth disease (HFMD) in recent three years,and to analyse the risk factors of severe HFMD.Methods A multicenter collaborative research group was set up,including five children's hospitals(pediatric department)with high incidence of HFMD.Prospective epidemiologic approaches were adopted.After training,staffs from the col-laborative center executed the study by filling up the record forms.Results We collected 114 HFMD cases in stage 2,75 cases of HFMD in stage 3,37 cases of HFMD in stage 4 from April 2014 to October 2016.The age ranged from 2 months to 13 years old,the median age was 2 years old,younger than 3 years accounted for 86.3%.Fever was observed in all the severe HFMD,mean temperature was (39.2 ± 0.7) ℃,fever lasted for (4.54 ± 2.89)d.The mean heart rates in stage 2,3,4 were (128.2 ± 13.3,176.1 ± 22.2,184.2 ± 27.5) times/min,respectively.The mean arterial pressure was (84.4 ± 14.6) mmHg(1 mmHg=0.133 kPa),the mean respiratory rate was (39.0 ± 8.4)times/min,the mean respiratory rates in stage 2,3,4 were (37.8 ± 7.36,38.7 ± 8.13,43.4 ± 10.7) times/min,respectively. Respiratory rhythm abnormality in stage 2,3,4 were 9.6%,14.9% and 56.8%,respectively.The blood glucose increased gradually in 2,3 and 4 stages,the mean blood glucose in stage 4 was(12.4 ± 4.74)mmol/L.The incidence of coma in stage 4 was higher than those in stage 2 and 3. Multivariate Logistic regression analysis found that tachycardia,drowsiness,coma, respiratory rate increase,respiratory rhythm abnormality,capillary refilling time more than 3 seconds were risk factors for severe HFMD.Conclusion The incidence of severe HFMD is still high in children under 3 years of age in last three years.The severe patients have obvious changes in the nervous,respiratory and circulatory system. Tachycardia,drowsiness,coma,respiratory rate increase,respiratoy rhythm abnormality,capillary refilling time more than 3 seconds are risk factors for severe HFMD.

Objective To study the levels of plasma catecholamine( norepinephrine,epinephrine and dopamine) in children with severe hand,foot and mouth disease( HFMD) ,and to assess the influence of cate-cholamine on the pathogenesis of severe HFMD. Methods A collaborative study group was established, including Children′s Hospital of Fudan University, Jiangxi Provincial Children′s Hospital, Anhui Provincial Children′s Hospital,Linyi People′s Hospital and No. 2 People′s Hospital of Fuyang City. Blood samples from children with severe HFMD were collected from April 2014 to October 2016. The levels of blood epineph-rine,norepinephrine,dopamine were measured at 2 h,24 h and 48 h after diagnosis for HFMD. Results The level of epinephrine at 24 h after diagnosis was ( 213. 0 ± 139. 8 ) ng/L in children with pulmonary edema, which was significantly higher than that of children without pulmonary edema[(137. 8 ± 45. 5)ng/L)](P=0. 022). The level of epinephrine at 24 h after diagnosis was (373. 2 ± 298. 1)ng/L in the dead children,and was (144. 2 ± 42. 5)ng/L in the survival children. The concentration of norepinephrine at 24 h after diagnosis was (1935. 7 ± 1824. 1)ng/L in the dead children,and was (858. 3 ± 212. 7)ng/L in the survival children. The levels of epinephrine and norepinephrine of those who died from HFMD were significantly higher than those of survival children at 24 h after diagnosis. There were no significant differences in catecholamine con-centrations among stage 2,3,4 HFMDs at 2 h,24 h and 48 h after diagnosis. Sex and enterovirus 71 virus infection had no significant influences on plasma catecholamine concentrations in children with severe HFMD. Conclusion Plasma epinephrine levels increase in children with HFMD complicated with pulmonary edema. Epinephrine and norepinephrine may play an important role in the death of children with severe HFMD.

AIM To establish the UPLC fingerprints of Bushen Qiangshen Tablets (Epimedii Folium,Cuscutae Semen,Rosae Laevigatae Fructus,etc.).METHODS The analysis of 50％ ethanol extract of this drug was performed on a 40 ℃ thermostatic Agilent SB-C18 column (100 mm ×4.6 mm,2.7 μm),with the mobile phase comprising of acetonitrile-0.1％ phosphoric acid flowing at 0.5 mL/min in a gradient elution manner,and the detection wavelength was set at 215 nm.Then the fringerprints were evaluated by cluster analysis,principal components analysis and orthogonal partial least squares discriminant analysis.RESULTS There were twenty common peaks in the UPLC fingerprints of twelve batches of samples,nine of which (protocatechuic acid,salidroside,chlorogenic acid,hyperin,specnuezhenide,epimedin C,icariin,kaempferide and baohuoside Ⅰ) were identified,with the similarities of 0.843-0.970.Twelve batches of samples could be divided into three types,and four differential markers,including specnuezhenide and chlorogenic acid,were found out.CONCLUSION This simple and reliable method can be used for the quality control of Bushen Qiangshen Tablets.

Objective To explore depression and anxiety in nasopharyngeal carcinoma (NPC) patients in Chaoshan region and investigate their influencing factors. Methods Two hundred and one patients newly diagnosed with NPC were included in this study. The status of depression and anxiety during their hospital stay were evaluated using the self-rating depression scale (SDS) and the self-rating anxiety scale (SAS). Data including sex, age, education, history of smoking, course of disease, sleeping quality and oral pain were also collected and their relationships with depression and anxiety were analyzed as well. Results They had significantly higher mean SAS score (36.41 ± 7.41) and SDS score (48.42 ± 7.19), as compared with the healthy population. Single factor analysis indicated that age, education, history of smoking, course of disease, sleeping quality, and oral pain had significant impact on the scores of SAS and SDS. Multivariate logistics regression analysis indicated that age, education, history of smoking, course of disease, sleeping quality, and oral pain had significant impact on their anxiety and depression. Conclusions Depression and anxiety are common psychological problems in NPC patients. Patients at the middle to elderly age and with low education, history of smoking, bad sleeping quality and oral pain are more susceptible to depression and anxiety.

Objective:To compare two flexible embryo catheters and determine whether clinical out-come differs in the in vitro fertilization-embryo transfer (IVF-ET)cycles.Methods:This prospective control study was conducted by one doctor between July 2012 and November 2013.In the study,2 064 patients undergoing fresh embryo transfer by using IVF-ET/intracytoplasmic sperm injection (ICSI)-ET in Reproductive Medical Center of Peking University Third Hospital were recruited.The subjects were di-vided into two groups.Cook Sydney IVF embryo transfer catheters (product model:K-JETS-7019-SIVF) were used for embryo transfer in group 1 (n =949),and FrydmanCCD catheters (product model:131230301)were used in group 2 (n =1 115).Pregnancy outcomes were compared between these two groups.Results:There was no significant difference in age,diagnosis for infertility and stimulation proto-col used between the two groups.In addition,there was no difference in the number of oocytes collected and in the number and score of embryos transferred.The significantly higher implantation rate,clinical pregnancy rate,and live birth rate (34.40% vs.26.92%,51.21% vs.41.52%,42.57% vs. 33.09%,P <0.05)were observed in group 1 compared with group 2.The abortion rate was not signifi-cantly different between the two groups (11.93% vs.15.98%,P >0.05).The proportion of difficult transfer was higher in group 1 than that in group 2 (5.27% vs.3.41%,P <0.05 ).There was no difference in the clinical pregnancy rate and live birth rate between the two difficult transfer cycles.Con-clusion:The type of embryo transfer catheter affects the clinical outcome in IVF.Good clinical outcome can be obtained by using Cook Sydney IVF catheter,which is worthy of clinical promotion.

Objective To investigate Monilia infection and adverse pregnancy outcomes of pregnant women in labor.Methods Before informed consent,542 cases of pregnant women in labor were collected in Obstetrics Department of Maternity and Child Healthcare of Maoming City from January 2013 to April 2014,and all of these cases were examined by Monilia inspec-tion of vaginal secretions.All of these cases were 20 to 30 years old,without vaginal pathogenic infection symptoms,but in-cluded in a few of formulation of clinical features of vaginal Candida infection.With the two methods of 10% potassium hy-droxide solution wet sheet and Gram staining,if blastospore or pseudohypha of Candida mycoderma were found out in the two methods under microscope,this case was diagnosed as positive result,otherwise as negative result.Respectively choosing positive cases as observation group,and negative cases as control group,the indexes of premature rupture of membranes,per-ineum wound infection,neonatal thrush and neonatal diaper rash of the two groups were recorded.The statistical method:e-numeration data by chi-square test,measurement data using analysis of varianc.Results The positive rate of Monilia was 23.1% (125/542),higher than 19.3% reported in domestic.The incidence rates of neonatal diaper rash,premature rupture of membranes,neonatal thrush and perineum wound infection of the observation group were respectively 19.2%,8.0%, 16.8% and 12.8%,all much higher than the control group respectively was 8.4%,1.2%,3.8% and 1.7%,(χ2 =12.578~29.273,all P <0.01).Conclusion Monilia infection of pregnant women in labor could increase the chance of adverse preg-nancy outcomes.Healthy or clinical doctors should suggest that pregnant women early carry out routine examination and ear-ly treatment,in order to prevent adverse pregnancy outcomes.

Objective To explore the prognostic value of N-terminal pro-brain natriuretic peptide ( NT-pro-BNP) levels in critically ill infants. Methods Eighty-one critically ill infants were enrolled from January 2013 to January 2014 in pediatric intensive care unit. The minimum of pediatric critical illness score ( PCIS) and the number of dysfunction organs were calculated within 24 hour after admission. According to PCIS,the critically ill infants were divided into extremely critical group(PCIS≤70,n=25),critical group (PCIS 71-80,n=30)and non-critical group(PCIS>80,n=26). According to the prognosis,the critically ill infants were divided into survival group (n=68)and death group(n=13). The serum NT-pro-BNP levels were determined on the first day,third day and convalescent phase. The relationships of serum NT-pro-BNP levels with PCIS and the number of dysfunction organs and prognosis were observed. Results The study showed statistical significances of serum NT-pro-BNP levels among the extremely critical group, critical group and non-critical group,whether on the first day,or on the third day and convalescent phase(P<0. 01). There were statistical significances of serum NT-pro-BNP levels among different stages of the disease in each group(P<0. 01). Compared with survival group,PCIS was significantly lower and the serum NT-pro-BNP levels and the number of dysfunction organs were significantly higher in death group. The serum NT-pro-BNP level on the third day was higher than that on the first day in death group ( P<0. 01 ) , while no significant difference was found in survival group. The serum NT-pro-BNP levels on the first day and the third day and PCIS were negatively correlated(r= -0. 59,P<0. 01;r= -0. 66,P<0. 01). The serum NT-pro-BNP levels on the first day and the third day and the number of dysfunction organs were positively correlated(r=0. 40,P<0. 05;r=0. 57,P<0. 01). Conclusion The serum NT-pro-BNP levels of the critically ill infants are correlated with disease severity,and can be useful for assessing the severity of critical illness.